How ECRI created the list

ECRI and the Institute for Safe Medication Practices (ISMP) reviewed millions of reported patient safety events and surveyed their members to nominate patient and workforce safety concerns for evaluation. Nominators supported their proposals with information from scientific literature, event reports, causal analyses, and more.

A cross-disciplinary team of ECRI and ISMP experts then evaluated each nominated topic using the following criteria:

• Severity: How seriously would patients be harmed if this safety issue occurred?
• Frequency: How likely is this safety issue to occur?
• Breadth: How many patients would be affected if this safety issue occurred?
• Insidiousness: Is this issue difficult to recognize or challenging to address once it occurs?
• Profile: Would this safety issue put significant pressure on an organization?

Based on this, the team chose and ranked the top 10 patient safety concerns.

The top 10 patient safety concerns for 2024

The ECRI and ISMP team concluded that the top 10 patient safety concerns for 2024 are:

1.       New clinicians transitioning from education to practice

2.       Workarounds for barcode medication administration systems

3.       Barriers to maternal and perinatal care

4.       Unintended consequences of new technology

5.       Healthcare workers' declining physical and emotional well-being

6.       Harm from diagnostic errors

7.       Providing equitable care for individuals with physical and intellectual disabilities

8.       Care delays due to drug, supply, and equipment shortages

9.       Misuse of parenteral syringes to administer oral liquid medications

10.   Difficulties preventing patient falls

Commentary

According to Marcus Schabacker, president and CEO of ECRI, the concerns on this year's list were largely related to the industry-wide workforce crisis.

"Many of our patient safety concerns for 2024 are exacerbated by a shortage of prepared healthcare clinicians," Schabacker said. "Through no fault of their own, clinicians who started practicing medicine in the last several years didn't have the same early experience as those who came before them–before the pandemic laid bare critical weaknesses in our healthcare system," he added.

Many clinicians who graduated within the last few years have also faced dramatic shifts in the healthcare field, including teachers and mentors leaving, a rise in new technology like artificial intelligence, and higher patient volumes.

"All those factors are making it dramatically more difficult for these new clinicians to get the necessary experience in a supervised controlled environment," Schabacker said. "So they're often thrown in the midst of it and have to figure it out. That causes pretty significant stress and safety concerns from our perspective."

Notably, the Agency for Healthcare Research and Quality found that newer clinicians are less likely to bring up safety issues than their more experienced colleagues. Only 33% of clinicians with less than a year of experience voluntarily reported safety events in 2022. In comparison, 50% of clinicians with six to 10 years of experience reported safety events during that same period.

"It is very concerning to us that these less experienced clinicians seem to lack the confidence or an understanding of the importance of reporting safety events," Schabacker said.

To address the issue of inexperienced clinicians, ECRI recommends that healthcare organizations:

• Collaborate with academic institutions to create more opportunities for hands-on and simulation-based learning
• Develop transition to practice programs with preceptorships
• Include patient safety training as an essential educational component for new healthcare professionals

According to Akin Demehin, senior director of quality and patient safety policy at the American Hospital Association, health systems are implementing more structured orientation processes to ensure that first-year clinicians have the necessary support and resources they need to succeed.

"Giving those who are new to organizations a strong foundation and support as they transition is a real priority for hospitals and something that they work at through orientation program," Demehin said. (Muoio, Fierce Healthcare, 3/11; Devereaux, Modern Healthcare, 3/12; Davila, ECRI, 3/12; ECRI, "Top 10 Patient Safety Concerns 2024," accessed 3/13)

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